Kudos to Steve Breckler, PhD, for calling attention to the relative neglect, by our community of psychologists, of the issue of global climate change (April Monitor, "Rising to the challenge"). We want to draw attention to his point that research in this area, though sparse, does exist and there are people who have been working on it for decades. Currently, a growing number who can be called conservation psychologists are trying to tackle environmental issues in their research, and several symposia at this summer's APA convention will be related to the topic.
There is an urgent need to apply skills from across psychology to address the many environmental challenges facing humanity: not only climate change, but loss of biodiversity, increased exposure to environmental toxins and degradation of natural resources. Psychologists from many subdisciplines can help people cope with these changes, motivate behavior change to mitigate that deterioration and possibly promote a more healthy relationship with the natural systems on which we depend.
In the 1990s, I surveyed division presidents about their position on environmental issues and was dismayed to get at least one response, "What does psychology have to do with the environment?" Short answer: Psychology is about understanding human behavior and promoting human welfare. Perhaps we are finally approaching an APA-wide recognition of the relevance of environment to psychology, and a societal recognition of the important role psychologists can play in responding to the environmental crises.
Wildlife Conservation Society, Bronx, N.Y.
Meeting military needs
We applaud APA in creating a task force to help address the mental health needs of our military service members and their families, and to investigate the problems in meeting those needs. We read with interest, "An unmet need" in the April Monitor. However, as a group practice who serves many active duty military members and their families, we were surprised that you did not mention reimbursement issues and non-military providers as part of the problem hindering them in gaining access to mental health care.
Our practice serves active duty military members and their families, many of whom live in the area, and many of whom drive 45 miles from a nearby base because they cannot find a local provider. It is no wonder that it is difficult for them to find providers who accept their insurance, as many providers do not want to contract with them because of the reimbursement rates. Recently, we discovered that two of our psychologists were being reimbursed by Tricare at 75 percent of the TMAC (Tricare Maximal Allowable Charge) rate, and one psychologist was being reimbursed at 95 percent of TMAC. In our state, TMAC rates are basically the same rates as Medicare, which of course are low compared to most third-party payers. Upon this discovery, we contacted Tricare assuming the 75 percent rate was a mistake. It could never be explained why the psychologists were being reimbursed differently, since we contracted as a group. And, we were never offered back-pay for the "error," which Tricare insinuated we must have agreed to. After six weeks of bureaucratic phone tag, we finally got Tricare to agree to pay our PhDs 98 percent of the TMAC rates (MDs get 100 percent). We still find these rates to be unacceptable and very low compared to most third-party payers.
By not providing competitive rates for services, Tricare discredits and devalues what psychology has to offer. Our military service members and their families sacrifice a lot for our country. They deserve access to quality mental health services. And, those offering the services deserve to be paid competitive rates.
Gabriele D. Jones, PhD, Donna Weiner,
PhD, Greg Walton, PhD, and Robert A. Fleury, MD
Carolina Behavioral Care
I read with interest the article in the March Monitor titled "A new diagnosis for childhood trauma?" As a clinical psychologist, I spend two days a week providing mental health services at Tongue Point Job Corps Center in Astoria, Ore. From my work there I have observed that a very large portion of the students fit the criteria listed in the article.
The vast majority of youth in the program have been exposed to "traumatic" upbringings. They spent most years of their childhood in environments that offered recurrent abandonment, betrayal, and physical, sexual and emotional abuse.
I see a major difference between the traumas these youth endure and the prototypical trauma of post-traumatic stress disorder. These youth come to Job Corps clearly disregulated in thoughts, emotions and behaviors. It is not surprising to find that they have skipped large amounts of school, "hate" their families, have run away and lived on the streets, have used substances heavily, and have been unsuccessful at entry-level jobs.
I think that it is reasonable to believe that if the cause of the problem was a "developmentally adverse interpersonal environment," then an effective treatment would be to provide that of which they were deprived.
David Wigutoff, PhD
I found your March Monitor piece on the robot prodigy fascinating; I think this research will be truly revelatory and important to developmental psychology.
As I suspect the researchers know, the next step is to program in neurons that go beyond vision and hearing to register "interesting environmental cues" of touch as well as internal cues-your robot baby has to get hungry.
Finally, they need to program in an amygdala, with connections to all other neurons with some central organizer if they want to get autism.
Jean Carl Cohen, PhD
I recently read about "pay for performance" (P4P), a supposedly growing trend in consumer-driven health care. Under P4P some portion of insurance reimbursement would depend on the health-care provider meeting certain performance criteria, such as documenting treatment compliance and demonstrating positive outcomes. I am dubious of P4P, but my distrust would be greatly alleviated if it were applied fairly and across the board. That is, P4P should also apply to the insurance industry. I propose that insurance companies be rated on a set of criteria analogous to those they propose for health-care providers, such as responsiveness to consumers and providers, speed of reimbursement and their ability to trim overhead (e.g., by greatly reducing or even eliminating costly and superfluous recertification). Any insurance company that does not meet specific performance criteria would then be penalized some portion of its profits, with the funds going into a national pool to assist the underinsured.
If insurance companies would be willing to take some of the medicine they dished out, we all might be a bit more compliant.
Steve K.D. Eichel, PhD
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